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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by EERRIICC on February 21, 2005, at 19:34:22
1: Biol Psychiatry. 2005 Feb 15;57(4):430-2. Related Articles, Links
An open-label trial of the glutamate-modulating agent riluzole in combination with lithium for the treatment of bipolar depression.Zarate CA Jr, Quiroz JA, Singh JB, Denicoff KD, De Jesus G, Luckenbaugh DA, Charney DS, Manji HK.
Laboratory of Molecular Pathophysiology, National Institute of Mental Health, Bethesda, Maryland; Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, Maryland.
BACKGROUND: Preclinical and clinical evidence indicate that the glutamatergic system might play a role in the pathophysiology of mood disorders. This study was conducted to determine the efficacy and safety of riluzole, a glutamate-modulating agent, in bipolar depression. METHODS: This was an 8-week add-on study of riluzole in combination with lithium in acutely depressed bipolar patients aged 18 years and older. After open treatment with lithium for a minimum period of 4 weeks, subjects who continued to have a Montgomery-Asberg Depression Rating Scale (MADRS) score of >/=20 received riluzole (50-200 mg/day) for 8 weeks. RESULTS: Fourteen bipolar depressed patients entered the study. The linear mixed models for total MADRS score showed a significant treatment effect. No switch into hypomania or mania was observed. Overall, riluzole was well tolerated. CONCLUSIONS: Although preliminary, these results suggest that riluzole might indeed have antidepressant efficacy in subjects with bipolar depression.
PMID: 15705360 [PubMed - in process]
Posted by linkadge on February 21, 2005, at 22:20:59
In reply to New_Riluzole_study_published, posted by EERRIICC on February 21, 2005, at 19:34:22
Me and my mother (who takes just lithium) have noticed an antidepressant effect from Theanine. A component in green tea which has glutamatergic modulating effects.
Linkadge
Posted by SLS on February 22, 2005, at 7:38:35
In reply to New_Riluzole_study_published, posted by EERRIICC on February 21, 2005, at 19:34:22
Hi.
I suffer from bipolar depression. I hope riluzole (Rilutek) helps others more than it helped me. Although I didn't experience anything positive, I didn't experience anything untoward either.
Riluzole is prohibitively expensive, and the drug company wants to keep it that way. The company even denied the NIMH request to donate a supply of the drug for their investigation.
Currently the only FDA approved indication for riluzole is for the treatment of ALS (amyotrophic lateral sclerosis).
- Scott.> 1: Biol Psychiatry. 2005 Feb 15;57(4):430-2. Related Articles, Links
>
>
> An open-label trial of the glutamate-modulating agent riluzole in combination with lithium for the treatment of bipolar depression.
>
> Zarate CA Jr, Quiroz JA, Singh JB, Denicoff KD, De Jesus G, Luckenbaugh DA, Charney DS, Manji HK.
>
> Laboratory of Molecular Pathophysiology, National Institute of Mental Health, Bethesda, Maryland; Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, Maryland.
>
> BACKGROUND: Preclinical and clinical evidence indicate that the glutamatergic system might play a role in the pathophysiology of mood disorders. This study was conducted to determine the efficacy and safety of riluzole, a glutamate-modulating agent, in bipolar depression. METHODS: This was an 8-week add-on study of riluzole in combination with lithium in acutely depressed bipolar patients aged 18 years and older. After open treatment with lithium for a minimum period of 4 weeks, subjects who continued to have a Montgomery-Asberg Depression Rating Scale (MADRS) score of >/=20 received riluzole (50-200 mg/day) for 8 weeks. RESULTS: Fourteen bipolar depressed patients entered the study. The linear mixed models for total MADRS score showed a significant treatment effect. No switch into hypomania or mania was observed. Overall, riluzole was well tolerated. CONCLUSIONS: Although preliminary, these results suggest that riluzole might indeed have antidepressant efficacy in subjects with bipolar depression.
>
> PMID: 15705360 [PubMed - in process]
>
Posted by EERRIICC on February 22, 2005, at 16:29:22
In reply to Re: New_Riluzole_study_published, posted by SLS on February 22, 2005, at 7:38:35
Scott,
I've read many of your posts and I am impressed with your knowledge and your insight into affective disorders. The fact that your illness has been refractory must be extremely frustrating. Did you try high dose Parnate yet? 150mg a day got me through university, but then stopped working. After this it would work again for about three months if I took a couple months off in between. Any idea why Parnate does this, or how to prevent tolerance? What are your views regarding NMDA antagonists to prevent amphetamine and opiate tolerance? Have you ever heard of Deep Brain Stimulation (for depression)?
Thanks,
Eric
Posted by SLS on February 22, 2005, at 17:00:57
In reply to Your_thoughts? » SLS, posted by EERRIICC on February 22, 2005, at 16:29:22
Hi Eric.
> I've read many of your posts and I am impressed with your knowledge and your insight into affective disorders. The fact that your illness has been refractory must be extremely frustrating.
Frustrating as hell.
> Did you try high dose Parnate yet?
I went up to Parnate 150mg + desipramine 300mg + Lamictal. I did feel a bit "brainier" for a little while, but this pretty much "pooped-out" after 3 months - similar to the time course you describe.
> 150mg a day got me through university,
What a blessing.
> but then stopped working.
MF
> After this it would work again for about three months if I took a couple months off in between. Any idea why Parnate does this, or how to prevent tolerance?
That's the big question. I'm looking for some ideas myself. I added memantine (Namenda), a non-competitive NMDA glutamate receptor antagonist that some people think can prevent tolerance to opioids and perhaps stimulants. I started taking Parnate just a few months ago. I'll let you know if I hit pay-dirt, but I am not expecting to. The preliminary indicators of a positive response that consistently appear for me have not at this point. I guess I don't want to get my hopes up. Then again, I've only been taking the memantine for 10 days or so. I sometimes go around in circles between optimism and despair when I'm trying something new.
> What are your views regarding NMDA antagonists to prevent amphetamine and opiate tolerance?
I think there is sufficient evidence that memantine can prevent tolerance to the nociceptive actions of opioids that it should be looked at more intensively. I haven't seen as much published regarding its effects on stimulants. I know one person who reports that memantine has worked wonders when added to Adderall.
I tried memantine over the summer when I was taking imipramine in the absence of an MAOI. I experienced a mild-moderate response to it that was somewhat episodic over the course of two weeks before it stopped working.
This is what I'm taking now to treat bipolar depression.
Parnate 70mg
nortriptyline 100mg
Lamictal 300mg
Abilify 10mg
memantine 20mgThe results so far are woefully inadequate. If I am pleasantly surprised by memantine + Parnate, you'll be the second to know! (I'll be the first)
:-)
> Have you ever heard of Deep Brain Stimulation (for depression)?
I've seen it do some miraculous things for Parkinsons Disease. It wouldn't surprise me if it had some utility in affective disorders. What have you read about it so far?
- Scott
Posted by EERRIICC on February 23, 2005, at 10:29:43
In reply to Re: Your_thoughts? » EERRIICC, posted by SLS on February 22, 2005, at 17:00:57
At Toronto General Hospital they are seeking people with refractory depression to participate in "a research study of a new surgical procedure to treat severe depression". The procedure involves implanted electrodes "that will stimulate specific areas". The effect of the surgery is monitored with fMRI and PET.
Posted by bipolarspectrum on February 23, 2005, at 11:41:48
In reply to D_B_S » SLS, posted by EERRIICC on February 23, 2005, at 10:29:43
Eric,
I thought abuot DBS at Toronto General too... But my pdoc flirted with me concerning the idea, only mentioning it but then retracting the idea... He said that I need to go through lots more trials.. I hear its also done at the Massacheutus (sp) hospital in America, 10-15 cases a year... Its all quite experimental, so one has no idea what to expect and its quite invasive surgery...
bps
Posted by bipolarspectrum on February 26, 2005, at 17:21:42
In reply to Re: D_B_S, posted by bipolarspectrum on February 23, 2005, at 11:41:48
Hi Eric,
I've heard that dbs is very good for intractable ocd... i've also heard that it works well for depression... hmmm, do u know anything more about it at the general? I know Dr. Kennedy is involved, but I'm wondering just how available it is?
Posted by temoigneur on February 27, 2005, at 2:33:47
In reply to More DBS TALK! apparently very good for OCD, posted by bipolarspectrum on February 26, 2005, at 17:21:42
> Hi Eric,
> I've heard that dbs is very good for intractable ocd... i've also heard that it works well for depression... hmmm, do u know anything more about it at the general? I know Dr. Kennedy is involved, but I'm wondering just how available it is?At the University of Florida, they're performing DBS on 6 treatment resistant OCD patients - I was being evaluated, but wasn't selected, as my anxiety issues are a little complicated.
Having said that, I'm very keen on finding a doctor that has experience in this very new area - just more than a handful of trials have been done, with some moderate to very encouraging responses.
One fellow convinced his neurologist to Try it for fairly severe tourettes, and it is in almost complete remission - the doctors were "amazed" I can post a link to the online before and after video.
I live in Canada, (Vancouver) does anyone know if any studies are being DBS for Tourettes/anxiety/OCD - I meet all treatment criteria CBT -- pharmaceuticals, etc.
So far efforts are being concentrated in Florida, as mentioned numerous trials have been conducted at Massachusets General Hospital with Dr. Greenburg, I'd never heard of Dr. Kennedy - is that just depression? It's also been done for OCD in Germany/Belgium
I'll see if I can post an article written by a prominent researcher on DBS for OCD, -
Posted by bipolarspectrum on February 27, 2005, at 13:08:56
In reply to Re: More DBS TALK! apparently very good for OCD, posted by temoigneur on February 27, 2005, at 2:33:47
Hi Teg,
Doesn't vancouver have a big new psychiatric centre?? I know this is being pursued at the Toronto General Hospital for depression... I'm not sure whether its being used for OCD there yet... I would assume so though.. But you probably need some sort of referal to get ur foot in the door at Toronto General... I know that dbs has taken place as I know of one patient that has had it... and a good thing is that in canada, the expensive equipment is covered by insurance!
bps
bps
Posted by bipolarspectrum on February 27, 2005, at 13:11:13
In reply to Re: More DBS TALK! apparently very good for OCD, posted by bipolarspectrum on February 27, 2005, at 13:08:56
Sorry,
One last thing.. tomorrow I see my pdoc in Toronto and will once again ask to pursue dbs... I suffer from severe bipolar depression and ocd.. but I'm young and they always say i havent been on enough trials... so ill keep u informed on how it goes...
bps
Posted by temoigneur on February 27, 2005, at 17:22:22
In reply to one last thing about dbs, posted by bipolarspectrum on February 27, 2005, at 13:11:13
> Sorry,
> One last thing.. tomorrow I see my pdoc in Toronto and will once again ask to pursue dbs... I suffer from severe bipolar depression and ocd.. but I'm young and they always say i havent been on enough trials... so ill keep u informed on how it goes...
> bpsBPS, that would be wonderful if you would, my aunt knew some neuropsychiatric nurses, who referred her to two doctors in TO that are up on the latest in the field of brain surger in conditions relating to synaptic or chemical disorders. Do you know them, Dr. Anthony Liang, or Lorenzo __ somebody,
I've been through everything, the full range of pharmaceuticals, from every class, I'm on clomipramine which leaves me really sedated, and still semi-symptomatic. I've been through 6 weeks of intsensive CBT thank you:)
Posted by Maxime on March 2, 2005, at 8:47:04
In reply to D_B_S » SLS, posted by EERRIICC on February 23, 2005, at 10:29:43
I have contacted them to find out more about the criteria that one would have to meet to be eligible. I hope to hear from them today.
Maxime
> At Toronto General Hospital they are seeking people with refractory depression to participate in "a research study of a new surgical procedure to treat severe depression". The procedure involves implanted electrodes "that will stimulate specific areas". The effect of the surgery is monitored with fMRI and PET.
Posted by Maxime on March 2, 2005, at 8:52:02
In reply to Re: D_B_S, posted by Maxime on March 2, 2005, at 8:47:04
Above is the link to info on the research being conducted in Toronto.
MAxime
This is the end of the thread.
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